Healthcare Provider Details

I. General information

NPI: 1346673274
Provider Name (Legal Business Name): ANTIONE J TRENT LCSW, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 08/05/2025
Certification Date: 08/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

IV. Provider business mailing address

615 SHIPYARD BLVD
WILMINGTON NC
28412-6431
US

V. Phone/Fax

Practice location:
  • Phone: 910-343-0145
  • Fax:
Mailing address:
  • Phone: 910-343-0145
  • Fax: 910-341-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-15597
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801095650
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: